March 14, 2012 | Posted By David Lemberg, M.S., D.C.

"Do no harm." This is the foundation of medical ethics. When interacting with a physician, the patient expects that the treatment she receives will not unknowingly cause more harm than the disease or disorder which brought her to the doctor's office. Presumably, the process of informed consent prepares the patient for untoward outcomes.

But the complexity of medical practice increases ongoingly and time spent with individual patients continues to diminish. To any reasonable observer these trends make no sense and are, intuitively, contradictory. Obviously, as a decision-making process becomes more complex, more time would necessarily be required to arrive at a meaningful solution. A highly correlated, direct relationship should obtain. In stark contrast to what would reasonably be expected, overall medical complexity and overall time spent in direct patient contact now have an inverse relationship.

The result is harm done to patients. Such harm may be deadly. An article published in JAMA in 20001 noted 225,000 deaths per year from iatrogenic causes, including 12,000 deaths per year from unnecessary surgery, 7000 deaths from medication errors in hospitals, 80,000 deaths per year from nosocomial infections, and 106,000 deaths per year from adverse effects of medications.

A primary cause of medical complexity is the prevalence of chronic disease, including diabetes, cancer, and cardiovascular disorders. Many persons with such disorders take multiple medications. The CDC report, "The State of Aging and Health in America 2004", notes that "the average 75-year-old has three chronic conditions and uses five different prescription drugs".2 If a physician treating such a patient doesn't take the time to evaluate the potential for drug-drug interactions, it is not unlikely that deadly consequences will ensue.

Solving our manifold health care problems requires an authentic intention to do so. The political will (which may well be an oxymoron) could derive from grass roots pressure. People as patients can have a real say in the matter of how the future of health care delivery will go. One way to start would be community-level discussions of single-payer health care. A clear advantage of a single-payer system is that it would immediately reduce third-party paperwork on the part of physician's offices and hospitals. Substantial reductions in time wasted in the effort to get paid would naturally translate into time available for patient consultations. The result would be enhanced delivery of appropriate treatment and enhanced patient outcomes.

1Is US Health Really the Best in the World?

2CDC Report

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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